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2020 CUA ABSTRACTS
Unmoderated Poster Session 1: Prostate Cancer, Endourology, BPH
UP-1.1 after photoselective vaporization of the prostate (PVP) with Greenlight XPS
A pilot study to assess efficacy and safety of methoxyflurane for 180W (GL XPS).
pain control during convective thermal therapy using Rezūm Methods: A retrospective analysis was conducted on patients who under-
system in benign prostatic hyperplasia (BPH) – Preliminary results went PVP GL XPS at the Centre hospitalier de l’Université de Montréal.
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Dean S. Elterman , Kevin C. Zorn , Naeem Bhojani 2 Data regarding patient characteristics, preoperative prostate volume, medi-
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1 Urology, University Health Network, Toronto, ON, Canada; Urology, cations, operative parameters, and PSA values were gathered for a period
Centre hospitalier, Université de Montréal, Montreal, QC, Canada of five years after the operation. Patients with a history of prostate cancer
were excluded. Data was stratified based on prostate volumes of <80 cc
Introduction: The optimal pain control protocol for Rezūm in benign pros- and >80 cc.
tatic hyperplasia (BPH) has not been determined. The use of low-dose Results: A total of 559 patients were included. Median age was 67 years,
methoxyflurane administered via a portable, disposable, single-use hand- with a median prostatic volume of 71 cc (interquartile range [IQR] 61–74).
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held inhaler (Penthrox ) was assessed in this study. Median preoperative PSA was 3.9 ng/ml (IQR 1.95–6.7). The PSA nadir was
Methods: An open-labeled, single-center pilot study was conducted to reached at 12 months postoperatively, with a median of 1.1 ng/ml (60.7%
demonstrate the safety and efficacy in patients undergoing Rezūm using reduction). No significant differences were recorded for mean PSA and
methoxyflurane inhaler on top of standard oral analgesia, including oral PSA change according to the use of 5-ARI or alpha-blockers preoperatively.
lorazepam, oral oxycodone, acetaminophen and intra-urethral lidocaine Preoperative PSA was significantly higher in patients with a prostate volume
gel. Intravenous propofol was used as rescue analgesia. Patients assessed >80 cc (p<0.001). Compared to patients with <80 cc prostates, postopera-
current pain intensity using visual analog scale (VAS) of pain at four time- tive PSA in patients in the >80 cc group was significantly higher at six, 12,
points including: 1) before any medication; 2) initially after insertion of 24, 36, and 60 months. For all prostate volumes, energy density of >4 kJ/
the rigid cystoscope and before any Rezūm treatment; 3) immediately after cc yielded significantly greater changes in median PSA at six, 12, 24, and
final injection of Rezūm treatment; and 4) at discharge. Patients were asked 36 months, with 66.6%, 69.7% 65.6%, and 65.4% PSA drop, respectively.
to rate on treatment satisfaction questionnaire for medication (TSQM 1.4) In the <80 cc prostate group, greater median PSA changes were recorded
and one question about pain relief at discharge. Treating physician also with a >4 kJ/cc energy density, compared to 3–4 kJ/cc and <3 kJ/cc, with
assessed on TSQM 1.4. 65.1%, 55.4%, and 52.1% median PSA changes at six months, respectively.
Results: Ten patients were planned for this study. Up to December 2019, Similar trends were recorded at 12 and 24 months. Higher energy similarly
five patients were recruited. The average prostate volume was 49.5 ml correlated with significantly higher median PSA changes at 6 and 12 months
(range 24–73 ml). Patients received average 10 Rezūm injections (range for prostates >80 cc, with 70.0% and 68.3%, respectively.
10–15), and procedure lasted average four minutes. Average VAS scores Conclusions: PSA levels reached the nadir at one year following PVP GL
were 0, 1.1, 1.5 (primary efficacy outcome) and 1.8, respectively, at the XPS, with slight increases during subsequent followups. Patients with >80
four timepoints. TSQM scores on effectiveness, side effects, convenience, cc prostates experienced a greater drop of PSA with every energy density
and global satisfaction rated by patients were 77.8, 95.0, 81.1, and 88.6, that the <80 cc group. Overall, an energy density of >4 kJ/cc consistently
respectively, while ratings by treating physician were 96.7, 100, 93.3, and yielded greater drops in PSA changes at six, 12, 24, and 36 months.
92.9, respectively. Treatment satisfaction on pain relief was rated as 4.0
(very good). There have been no adverse events so far.
Conclusions: Methoxyflurane inhaler on top of standard oral analgesia UP-1.3
was a feasible and easy to administer pain management in Rezūm ther- Rate of bladder stone recurrence in patients undergoing
apy. Further data on a larger comparative study is required after completing cystolitholapaxy with and without concurrent transurethral
this pilot study. resection of the prostate
Emily Whelan , Amanda Hird , Diana E. Magee , Sidney B. Radomski 1
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UP-1.2 1 Department of Urology, University of Toronto, Toronto, ON, Canada
Evolution of prostate-specific antigen according to prostate Introduction: To date, there is no long-term data on the rate of bladder
volume after photoselective vaporization of the prostate with stone recurrence in patients who undergo concurrent cystolitholapaxy
GreenLight XPS 18W: A five-year experience and transurethral resection of the prostate (TURP) and those who undergo
cystolitholapaxy alone. The objective of this study was to report on the
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Rhea Coriaty , Iman Sadri , Côme Tholomier , Félix Couture , David-Dan natural history of patients undergoing cystolitholapaxy with and without
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Nguyen , Kyle Law , Ahmed S. Zakaria , Naeem Bhojani , Dean S. Elterman , concurrent TURP.
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Esteban Rijo , V. Misrai , Kevin C. Zorn 5
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1 Faculty of Medicine, Université de Sherbrooke, Sherbrooke, QC, Methods: This prospective cohort study included males who presented with
Canada; Faculty of Medicine, McGill University, Montreal, QC, bladder stones secondary to bladder outlet obstruction between April 2001
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and January 2017. All patients underwent initial cystolitholapaxy with or
Canada; Department of Urology, McGill University, Montreal, QC, without concurrent TURP at a single institution. Patient outcomes reported
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Canada; Department of Urology, Université de Sherbrooke, Sherbrooke, QC, included rate and time to stone recurrence. Risk factors for stone recurrence
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Canada; Department of Urology of University of Montreal Hospital Centre, will also be examined.
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Université de Montréal, Montreal, QC, Canada; Urology of University Results: Of an initial cohort of 190 patients with bladder stones, 137 were
Health Network, University of Toronto, Toronto, ON, Canada; Department males who developed bladder stones secondary to bladder outlet obstruc-
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of Urology, Clinique Pasteur, Toulouse, France tion. Of the patients who previously underwent a TURP, 17% of them
Introduction: Prostate-specific antigen (PSA) testing remains the standard developed recurrent bladder stones, compared to 29% of patients who did
biochemical marker used both during screening and monitoring of prostate not have a TURP. Overall, 34 patients had recurrent bladder stones with
cancer. This study aims to clarify the changes in PSA kinetics in patients
S44 CUAJ • June 2020 • Volume 14, Issue 6(Suppl2)
© 2020 Canadian Urological Association